Journal of General Internal Medicine

, Volume 32, Issue 4, pp 449–457 | Cite as

Primary Care Providers’ Beliefs and Recommendations and Use of Screening Mammography by their Patients

  • Jennifer S. Haas
  • William E. Barlow
  • Marilyn M. Schapira
  • Charles D. MacLean
  • Carrie N. Klabunde
  • Brian L. Sprague
  • Elisabeth F. Beaber
  • Jane S. Chen
  • Asaf Bitton
  • Tracy Onega
  • Kimberly Harris
  • Anna N. A. Tosteson
  • on behalf of the PROSPR (Population-based Research Optimizing Screening through Personalized Regimens) consortium
Article

Abstract

Background

Revised breast cancer screening guidelines have fueled debate about the effectiveness and frequency of screening mammography, encouraging discussion between women and their providers.

Objective

To examine whether primary care providers’ (PCPs’) beliefs about the effectiveness and frequency of screening mammography are associated with utilization by their patients.

Design

Cross-sectional survey data from PCPs (2014) from three primary care networks affiliated with the Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium, linked with data about their patients’ mammography use (2011–2014).

Participants

PCPs (n = 209) and their female patients age 40–89 years without breast cancer (n = 30,233).

Main Measures

Outcomes included whether (1) women received a screening mammogram during a 2-year period; and (2) screened women had >1 mammogram during that period, reflecting annual screening. Principal independent variables were PCP beliefs about the effectiveness of mammography and their recommendations for screening frequency.

Key Results

Overall 65.2% of women received >1 screening mammogram. For women 40–48 years, mammography use was modestly lower for those cared for by PCPs who believed that screening was ineffective compared with those who believed it was somewhat or very effective (59.1%, 62.3%, and 64.7%; p = 0.019 after controlling for patient characteristics). Of women with PCPs who reported they did not recommend screening before age 50, 48.1% were nonetheless screened. For women age 49–74 years, the vast majority were cared for by providers who believed that screening was effective. Provider recommendations were not associated with screening frequency. For women ≥75 years, those cared for by providers who were uncertain about effectiveness had higher screening use (50.7%) than those cared for by providers who believed it was somewhat effective (42.8%). Patients of providers who did not recommend screening were less likely to be screened than were those whose providers recommended annual screening, yet 37.1% of patients whose providers recommended against screening still received screening.

Conclusions

PCP beliefs about mammography effectiveness and screening recommendations are only modestly associated with use, suggesting other likely influences on patient participation in mammography.

KEY WORDS

mammography variation in care provider beliefs 

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Copyright information

© Society of General Internal Medicine 2017

Authors and Affiliations

  • Jennifer S. Haas
    • 1
    • 2
    • 3
  • William E. Barlow
    • 4
  • Marilyn M. Schapira
    • 5
  • Charles D. MacLean
    • 7
  • Carrie N. Klabunde
    • 6
  • Brian L. Sprague
    • 7
  • Elisabeth F. Beaber
    • 4
  • Jane S. Chen
    • 1
  • Asaf Bitton
    • 1
    • 2
  • Tracy Onega
    • 8
  • Kimberly Harris
    • 1
  • Anna N. A. Tosteson
    • 8
  • on behalf of the PROSPR (Population-based Research Optimizing Screening through Personalized Regimens) consortium
  1. 1.Division of General Medicine and Primary CareBrigham and Women’s HospitalBostonUSA
  2. 2.Harvard Medical SchoolBostonUSA
  3. 3.Harvard T.H. Chan School of Public HealthBostonUSA
  4. 4.Fred Hutchinson Cancer Research CenterSeattleUSA
  5. 5.University of Pennsylvania and the Philadelphia VA Medical CenterPhiladelphiaUSA
  6. 6.Office of Disease Prevention, Office of the DirectorNational Institutes of HealthBethesdaUSA
  7. 7.University of VermontBurlingtonUSA
  8. 8.Geisel School of Medicine at Dartmouth and Norris Cotton Cancer CenterLebanonUSA

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